Brain aneurysms are caused when there is a weakened area in a blood vessel that begins to bulge or balloon out. Over time, the pressure exerted on the weakened area may cause the aneurysm to rupture, with potentially catastrophic results. When an aneurysm is found before rupturing, there are several strategies for aneurysm treatment.


You may be surprised to find out the first approach to treating an unruptured brain aneurysm is not always surgery. Sometimes aneurysms are found haphazardly when they are small. Your doctors will want to evaluate the size of the aneurysm to determine the risk of rupture. If the risk of rupture is small, monitoring the aneurysm and reducing the risk factors associated with rupture might be the best course. You may need to take medications that lower your blood pressure, which places less stress on the weakened portion of the vessel. Since any surgery carries risks and not all aneurysms progress to a point of having a high risk of rupturing, the risks associated with surgery now may be much higher than simply monitoring the aneurysm for a while.


The conventional method of treating aneurysms involves surgery to stop the flow of blood into the weakened area. During the procedure, an opening is made in the skull so the neurosurgeon can access the area of the brain where the targeted blood vessel is located. Once the vessel can be accessed, the aneurysm is clamped off by using a metal clip. This allows blood to continue to flow through the normal portion of the blood vessel and blood no longer puts additional stress on the "ballooned" portion. Once the aneurysm is clamped, the surgeon can replace the portion of the skull that was removed at the beginning of the procedure.


A newer and less invasive approach uses endovascular techniques to stop blood flow to the aneurysm. The procedure is done under the guidance of real-time imaging. A guidewire is threaded through a major blood vessel until it reaches the targeted area. Once the wire is in the appropriate location, a small coil is inserted inside the aneurysm. Much like an open procedure, blood can no longer flow to the aneurysm and increase pressure on the weakened area. After the coil is placed, the guidewire is removed. There is minimal healing time since the only incision made is to access a major blood vessel. The neurosurgeon will likely want repeat imaging so they are confident of the placement of the coil and that it is obstructing blood flow to the aneurysm.

Although the diagnosis of a brain aneurysm is intimidating, it does not mean there is imminent danger of rupture. When aneurysms are caught early, surgery may not be the first course of action.